As a geriatrician and a junior investigator, I am committed to an academic career in patient-oriented research. This K23 will lay the foundation for me to become an independent investigator, where I can lead translational interventions to attenuate functional decline in HIV-infected older adults (HOA). Aside from specific coursework and didactic readings, my growth in HIV and Aging will be enhanced from a mentoring panel who will contribute to my career growth. The career development plan features a strong, established, multi-disciplinary mentoring panel with experts in aging, HIV disease, behavior and motivation, clinical trials, body composition, physical frailty and exercise physiology. Additional key resources include University of Rochester's Clinical and Translational Science Institute and its Developmental Center for AIDS Research. The targeted training will not only improve my knowledge in HIV and Aging, but also will put me in a competitive position to apply for a NIH R01 that supports a clinical trial designed to ameliorate frailty in HOA. The improved survival of HOA has significant implications with respect to their functional status and quality of life (QOL). Further, HOA with central obesity are at increased risk of frailty and accelerated functional decline. While it is known that exercise can improve physical function in the general older population, the HIV-infected population, itself, is a challenging cohort with respect to behavior change, and consequently this population may find it difficult to initiate and comply with an exercise program. Consequently, the aims of the research plan herein is 1) to investigate the feasibility of an individually tailored home-based exercise program in combination with motivational counseling based on the self determination theory (SDT) of behavior change and 2) to determine its potential efficacy in improving physical function, body composition and exercise-related psychological mediators in HOA with central obesity. We propose to pilot test the intervention with a randomized controlled clinical trial. HOA with central obesity will be randomized to either maintain their usual activities or to receive the home-based exercise program in combination with motivation counseling based on SDT of behavior change. The preliminary data obtained from this feasibility study will be used to calculate the correct sample size to conduct a larger efficacy RCT, a potential R01 investigation. The overall goal of this research is to identify a feasible intervention that can be translated into the HOA community to attenuate functional decline and thereby improving health and QOL. The experience in study design and execution of the proposed research will be invaluable to my career growth and my transition to an independent investigator.

Public Health Relevance

HIV-infected older adults are an emerging subset of the general older population who are at high risk of frailty- related negative consequences. To attenuate functional decline and ameliorate frailty in this high risk population, the research proposal herein aims to advance our scientific knowledge by investigating a translational intervention. The proposal leverages considerable local resources.